Vitreoretinal surgery after inadvertent globe penetration during local ocular anesthesia.
OBJECTIVE
This study aimed to review visual morbidity resulting from inadvertent globe penetration during administration of local anesthetic and to identify the most appropriate management.


METHODS
The records of 20 consecutive patients referred to a specialist vitreoretinal unit over a 2-year period were reviewed.


METHODS
Twenty eyes of 20 consecutive patients were included.


METHODS
Observations included type of local anesthetic administered (e.g., retrobulbar or peribulbar), level of training of person administering the block, type of needle used for the block, and findings at presentation to the vitreoretinal unit. The authors also observed results of B-scan ultrasound evaluation of the retina, interval between the recognition of the complication and referral, as well as nature and timing of subsequent surgical intervention.


METHODS
Final visual acuity and retinal status (attached versus detached) were measured.


RESULTS
The most common presentation was vitreous hemorrhage observed from the first postoperative day. Ten eyes were found to have an associated retinal detachment on initial assessment in the vitreoretinal unit. These eyes generally had a poor visual outcome despite vitrectomy with long-acting gas or silicone oil tamponade. Seven (70%) of the remaining eyes with attached retina at the time of presentation achieved good visual recovery after vitrectomy.


CONCLUSIONS
The authors recommend prompt referral for consideration of early vitrectomy in eyes with dense vitreous hemorrhage after inadvertent globe penetration. This management may improve the overall visual prognosis by preventing subsequent retinal detachment.
Wearne
M J
MJ
Moorfields Eye Hospital, Vitreoretinal Unit, London, England.
Flaxel
C J
CJ
Gray
P
P
Sullivan
P M
PM
Cooling
R J
RJ
D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local; D015807:Eye Injuries, Penetrating / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016602:Needlestick Injuries / Q000209:etiology / Q000601:surgery*; D009915:Orbit / Q000293:injuries*; D012160:Retina / Q000293:injuries / Q000601:surgery*; D012163:Retinal Detachment / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D014792:Visual Acuity; D014821:Vitrectomy; D014823:Vitreous Hemorrhage / Q000209:etiology / Q000601:surgery
D000779:Anesthetics, Local